CancerIQ Seeks to Streamline Genetic Risk Screening

CHICAGO (GenomeWeb) – The daughter of a renowned genetic oncologist is making a name of her own by helming CancerIQ, an emerging software company that offers a suite of technology for streamlining genetic testing management and integrating clinical decision support.

Last month, CancerIQ moved into new digs in a downtown Chicago high-rise that once housed the American Medical Association. The offices were sparsely populated when GenomeWeb visited, as the company prepares to increase its workforce.

"We are hiring across the board for people to join our team," said CEO and Cofounder Feyi Olopade Ayodele. CancerIQ, which has raised more than $5 million to date, also is in the midst of an official Series A round of venture capital that likely will close in 2019.

Ayodele's mother is medical oncologist Olufunmilayo Olopade, founder of the Center for Clinical Cancer Genetics at the University of Chicago, and a 2005 MacArthur Foundation "genius" fellow.

Olopade, who started a cancer risk clinic more than a decade before the first human genome was sequenced, serves as chief scientific officer of CancerIQ.

"Her mission is to use genetics to be able to predict, preempt, and actually prevent cancer," Ayodele said. CancerIQ has become a part of that mission.

Ayodele has a background in financial services. "As I was looking to invest in the healthcare space, I was actually developing an investment thesis around precision medicine and was really scratching my head as to why it wasn't taking off at the pace that I expected it would," she said.

She thus took a sabbatical from her financial job to work in her mother's clinic in order to learn the the field. "When you actually work in clinic, you realize that it's a lot more backwards than you think it is," Ayodele said.

"What they were doing [at the Cancer Risk Clinic] was great," Ayodele observed. "Everybody gets a genetic evaluation." Patients who are at high risk of developing cancer regularly come back for care and health management.

"But what it took to actually operate that clinic from a business perspective was millions of dollars in grant funding, students, genetic counselors, genetic counseling assistants, and the like," Ayodele said.

For a time in 2013, Ayodele was part of a team whose only responsibility was to call patients every six months and remind them that they needed to get an MRI. "This is absolutely not scalable outside of academic settings with the grant funding," she said.

She observed similar inefficiencies in a nonacademic setting, thanks to a collaboration the university had with City of Hope National Medical Center in Duarte, California. Olopade led this grant-supported program to train physicians in cancer genetics and teach health counselors at various sites around the country to perform hereditary cancer risk assessments.

"They trained all these people, but then they went back to their hospitals and they did nothing," Ayodele said.

"That was kind of the origin story for CancerIQ. It was actually accidental," Ayodele said.

"The problem was not about lowering the cost of genome sequencing and it wasn't about all those technologies. It was really about embedding it in clinical workflow and making it easier, more cost-efficient, and more doable in nonacademic settings. That was really the barrier to precision healthcare taking off."

So Ayodele and her mother — who took a sabbatical from the University of Chicago — joined with analytics specialist Haibo Lu to start CancerIQ. While still in the concept stage, the fledgling company was accepted into the San Francisco-based Rock Health tech accelerator program in 2013, which gave CancerIQ seed funding and access to Silicon Valley technological expertise.

"We really did our user research. We got all of my mother's equivalents in the academic world to be on our medical advisory board and actually guide us on the product," Ayodele said. They also consulted alumni of the University of Chicago-City of Hope training program.

"We wanted to make sure that it wasn't something that was only going to work at UCSF or a Silicon Valley-based health center because in San Francisco … it seems like everyone has their genome on their phone," Ayodele said, half-jokingly.

In early 2014, after the Rock Health mentorship ended, Ayodele decided to head back to Chicago. "I realized the product advisory board needed to be here in the Midwest," where the population is more reflective of the entire country, she said.

It was around that time that the startup built a product to address three problems that Ayodele observed in both academic and community health settings: identifying candidates for genetic testing, ordering genetic tests, and managing patients according to risk factors that tests uncover.

CancerIQ tested its technology at the University of Illinois at Chicago, at the public Stroger Hospital of Cook County, and at OSF HealthCare in Peoria, Illinois, because Ayodele wanted the system to work in a smaller urban environment, a safety-net hospital, and in the ivory towers of academia.

"We're increasing access in places that don't [have genetic risk-assessment programs] and we are improving productivity in places that do," she said. "You've got to work with both."

Today, the technology suite has three titles, called CancerIQ Navigator, Cancer IQ Specialist, and CancerIQ Manager. Major customers include UnitedHealth Group senior-care subsidiary OptumCare, Adventist Health System and Advocate Aurora Health.

Navigator, the original product, collects patient and family histories by means of an electronic questionnaire that flags patient eligible for genetic testing, according to National Comprehensive Cancer Network guidelines, which change every quarter. CancerIQ updates the decision tree as NCCN updates its guidelines.

Ayodele noted that testing for BRCA expanded this year to patients at high risk for prostate cancers.

Just this month, a study published in the Journal of Clinical Oncology said that NCCN genetic testing recommendations for detecting BRCA1 and BRCA2 are badly out of date and likely to miss many individuals who would benefit from testing. According to Ayodele, CancerIQ helps "connect the dots" between physicians and new medical knowledge.

Among other things, CancerIQ Navigator is meant to replace the dreaded clipboard patients would otherwise fill out at cancer screening centers. "That piece of paper just gets stored somewhere and nobody actually does anything about it," Ayodele said. "We've kind of brought that clipboard to light on a tablet so the provider … gets a yes/no button: Is this patient moving forward with the genetic evaluation or not?"

CancerIQ Specialist came about because Navigator proved to be highly effective.

"We found, on average, 20 to 25 percent of patients met criteria for a genetic counseling and testing appointment. That was higher than we anticipated, and it then overwhelmed the specialists who offer genetic counseling and testing services," Ayodele said.

Launched in 2015, CancerIQ Specialist is meant to streamline the evaluation process to make genetic counselors more efficient, she said. It also helps providers collect the documentation payors require for prior authorization.

"On average, providers spend five to six hours per patient doing a genetic evaluation by hand, and we needed to get that down," Ayodele said. Using what she described as a TurboTax-like interface — with the counselor simply tapping through a series of short questions based on previous responses — the software builds a pedigree, and generates risk models in about 30 minutes.

"It's used as a decision aid in the encounter with the patient," Ayodele said.

CancerIQ took another step forward in 2016 by partnering with laboratories so clinicians could order tests directly through an interface with Specialist. "Our goal was to make it as easy to order a genetic test as it is to order a [complete blood count] or to order something off of Amazon," Ayodele said.

By integrating with laboratory information systems, individual testing menus specific to each lab now pop up in CancerIQ. The system automatically populates the requisition form and insurance pre-authorization, then sends this information electronically to the lab.

"That was an accidental business opportunity that came for us," Ayodele said. "With the first genetic testing lab that was on our platform, we found that users found it easier to order from that lab than from ones that they needed to fill things out manually for."

This automation gain created yet another issue for CancerIQ. "Now you make the provider so efficient that they're seeing four times the amount of patients that they've ever seen and now they have a huge population of patients that tested positive or are in that medium-risk category that now need active management," Ayodele said.

Thus came CancerIQ Manager early in 2018 to help healthcare organizations coordinate care in high-risk programs to improve their compliance with treatment guidelines.

Ricki Gaber Caffrey, program coordinator of cancer risk evaluation at Advocate Illinois Masonic Medical Center in Chicago, was at one of CancerIQ's beta sites before taking her current job two years ago. "When I was hired here, I strongly recommended that we use that as a way for me to be the only cancer genetic counselor here, but still grow the program."

Illinois Masonic is the CancerIQ pilot site for Advocate Aurora Health, the product of the April merger between Downers Grove, Illinois-based Advocate Health Care and Milwaukee's Aurora Health Care.

Gaber Caffrey uses CancerIQ Specialist within the cancer clinic and CancerIQ Manager at a new hereditary cancer prevention clinic that the hospital set up after the merger, following a model that Aurora shared. "That allows us to follow patients over the years and keep track of whether they've had their colonoscopy or their breast MRI like we've planned," and to prompt the hospital to send referrals letters, if necessary. "It also helps us keep track for cascade testing of other family members for that patient as well," she said.

The software helps Gaber Caffrey better integrate genetic counseling work into each patient's care team, as well as improve interaction with patients, thanks to the visual element.

"I can show them the pedigree and show how we're going to put in who their family members are and I can show them the pattern of cancer in the family. I can show them the graphs that estimate the lifetime risk for breast cancer or the chance that there may be a mutation," she said. That is more helpful than just showing a number. "For a visual learner, I think it's really helpful."

Gaber Caffrey is hopeful that Illinois Masonic will bring CancerIQ Navigator to the breast imaging clinic and the gastrointestinal health clinic in 2019 for taking patient histories and building pedigrees. "It's a quick survey that allows any of the patients who are being seen in those centers to take that quick survey and then if they meet the criteria, that does get transferred over to my group and we do have dedicated personnel who track that navigator log, who then would be able to call the patient to make an appointment," she said.

Meanwhile, CancerIQ is beginning to close some loops with its customers because the system collects outcomes data, including how many patients met screening criteria, how many tested positive for certain mutations, and how many entered care management programs.  

"We now are full-circle with some of our earlier clients where we can actually quantify [that] of the 100 women that went in to get MRIs because they were high-risk, we found three cancers before they got to above 1 centimeter, which means we're actually doing what we say we do in terms of improving early detection," Ayodele said.

Integrations with major electronic medical records systems — notably Epic Systems and Cerner — and with breast imaging software — MRS Systems, PenRad Technologies, and Volpara — also are helping to improve the data flow. "We've tried to make it so that everybody touches CancerIQ at some point in the patient journey," Ayodele said.